I am happy to report that for the first time in two years, I (Mark) have health insurance, and Lisa Marie has it too for the first time in one year. And it was simple and cheap!
Technically we have been covered by the ASSE, the Administraciòn de Servicios de Salud del Estado, ever since June when we became eligible for provisional permanent residency. But that is the baseline, mostly poor-people-oriented, part of Uruguay’s three-tier universal health system. We will have another post upcoming that explains more about the different tiers, but for now, we’re covered!
We chose to join one of the larger of the mutualista groups, Asociación Española, at their polyclinic here in Atlántida. In January of this year they opened their first polyclinic in Atlántida, just a few blocks from our home, right on the rambla above the “brave beach” Playa Brava. Also a number of expat forums and blogs had recommended them, such as the Johnson’s posts about choosing them. The price has gone up a bit since they joined in 2008 at 1433 pesos monthly – yesterday Lisa paid $1633 ($ means Pesos in Uruguay, U$S means dollars), and that is without the funeral care supplement that the Johnsons chose – with that it would have been another $143 monthly, $1808 total, or about U$S 93 monthly. A private room supplement is 419 pesos monthly, or a bit under 22 dollars at today’s exchange rate.
We went with the basic plan, at the 1633 UYU (84 dollars USD) monthly. That is what Lisa pays, as she is not “active” in Uruguay – active meaning employed or self-employed (independiente con compañia unipersonal) paying into BPS. BPS is Uruguayan social security system.
Me, I don’t have to pay a peso to Española for my coverage, because I am now an employee of a Uruguayan company. I’ve mentioned on the Facebook & G+ pages for the blog that I now work for a BigCloudSoftwareCompany from Silicon Valley in a RealJob™. But actually I work for a small, maybe 40-person, Uruguayan startup that was building such cool stuff as a value-added partner of the big company that the big company bought them and runs them as a wholly-owned subsidiary. So the Uruguay company still exists, I am an immigrant to Uruguay with residency, working as a uruguayo, for a Uruguayan company. Not an “expat” posted to a “foreign” office. As such, I am enrolled in BPS, the company makes the required BPS contribution including the 6% of gross for medical (something like 4.5% of the negotiated “what you get” net which is how job salaries are defined here unlike USA). All I had to do was give the mutualista my cédula, say I want to enroll through BPS FONASA (The part of BPS that administers health care) and about 5 minutes later I was covered for free, retroactive to the start of November. I didn’t even start my job until Nov 12 and don’t get paid, thus no first contribution, until Nov 30, so that was pretty cool!
If I wanted the private room, the funeral service, or the emergency medical service through separate company SUAT, I would pay the extra fees, but the base membership is through my work, and would be free for any working Uruguayan. Including by law all immigrants permanent or provisionally permanent who are “active”. Spouses of active workers without their own activity are covered for an additional 2% BPS deduction if they have children under 18. As of December 1, concubines (yes that is the term, concubinos/concubinas), domestic partners, I believe of any gender including same-sex partnerships, can be covered under the same arrangements.
This isn’t my political blog, but all in all, the above beats the heck out of “Obamacare”, and the system before the USA’s Patient Protection and Affordable Care Act, the official name of so-called Health Reform. The reason Lisa and I did not have health insurance in USA is because even with 2010-2014 “transitional Obamacare”, you can be excluded for preexisting conditions, any condition at all, from buying individual health insurance, and the state/federal high-risk pools and Obamacare-mandated Preexisting Condition Insurance Plans have premiums of about USD 600/month, with annual deductibles before they pay of 2500 dollars, with then paying only 80% of what they feel is “reasonable and customary”, which they always define as lower than what your doctor or lab actually charges.
Note that nowhere in my description of our sign-up for our mutualista did I mention a health check, a pre-existing condition screening, or premiums based on preexisting conditions. Because none of that happens with this tier of the Uruguay Universal Healthcare System.
Sure, I have to go to their polyclinic. If I joined an HMO in the USA, the popular-in-1990s, now less-so, mode of going only to one network, I would have the same situation. The Mutualista system is much like the medical-home model that the US medical caregivers are starting to support for better health info coordination, and much like one of the two HMO models. That is the model where HMOs run their own clinics rather than simply being a payment network for private medical practices. The biggest examples of these are Kaiser Permanante in the USA West Coast and Harvard-Pilgrim Health Care in the Massachusetts area.
You cannot believe how relieved I am that we now have health care access. Oh, yes, we do have to pay a copay to see a doctor. $67. That is pesos, remember. About three dollars and fifty cents!